key: cord-0783038-q3o2b876 authors: Micoogullari, Uygar; Kisa, Erdem; Yucel, Cem; Ozbilen, Mert Hamza; Karaca, Erkin; Cakici, Mehmet Caglar; Ozcift, Burak; Ilbey, Yusuf Ozlem title: The effect of the first wave of COVID‐19 pandemic on urology practice and anxiety scores of patients awaiting surgery date: 2021-04-17 journal: Int J Clin Pract DOI: 10.1111/ijcp.14201 sha: 13cbf56f77cc9b52749556ec6795d85fbf1c415d doc_id: 783038 cord_uid: q3o2b876 OBJECTIVE: We aimed to determine the effect COVID‐19 pandemic on the daily urology practice of the level 3 centre located in one of the most affected regions in Turkey. We also aimed to assess anxiety and depression levels of patients whose procedures and surgeries had to be postponed due to COVID‐19‐related restrictions. METHODS: The number of patients admitted to the outpatient clinic, outpatient procedures, emergency consultation requests, hospitalised patients and the total number of surgeries between March 10, 2020 and June 15, 2020 were evaluated. These numbers were compared with the same period of 2019. Subsequently, patients who could not be operated or whose elective surgeries were postponed between March 10, 2020 and June 15, 2020 were determined(n:96). These patients were asked to fill out Beck Depression Inventory(BDI) and State‐Trait Anxiety Inventory(STAI). The presence of difference between the baseline anxiety levels and the anxiety levels during the COVID‐19 pandemic was investigated. Afterwards, these patients were divided into two groups based on planned procedures as oncological group (group1) and non‐oncological group (group2). The presence of a difference between the anxiety and depression levels between the groups was investigated. RESULTS: There was a drastic decline in number of patients in all assessed parameters. The least amount of change was seen in the number of emergency consultations. The evaluation of anxiety and depression scores of the patients showed a significant difference between their STAI‐S and STAI‐T scores (51.8 ± 9.3, 38.2 ± 7.5, respectively)(P < .001). STAI‐S scores of the patients were found to be compatible with severe anxiety. The patients’ mean BDI score was found to be 15 ± 8.9, which indicated mild depression. However, the age and STAI‐S values were significantly higher in group1. CONCLUSION: We noted that anxiety and depression levels increased in patients whose operations were delayed because of pandemic‐related restrictions, especially in oncological patients. We believe that an important contribution can be made to the protection of public health by planning advance psychosocial interventions for high‐risk groups during pandemics. A severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mainly causes cough, fever and myalgia, and results in coronavirus disease 2019 (COVID- 19) , which is highly infectious. 1 is not directly related to the urinary system; however, since even asymptomatic carriers could transmit COVID-19 to another person during the incubation period, patients visiting urology clinics can still be at risk for transmission. 2 The high risk of transmission and rapid spread of the virus have caused a great burden on health systems worldwide and caused widespread economic and social deterioration. 1 As in the whole world, because of the measures taken by Turkish state and health system administrators, all hospitals in Turkey stopped performing elective surgeries only allowing emergency and priority surgeries. This has led to a significant decrease in outpatient clinic admissions. In this context, the urology clinic of our hospital continued to carry out emergency, priority cancer surgeries and outpatient procedures according to the guideline published by the European Association of Urology during the Covid-19 period (Table 1) . 3 Although urgent and priority procedures continued in our What's known • We detected a dramatic decrease in the number of patients applying and being admitted to the outpatient clinic, number of emergency consultations, number of hospitalized patients, total number of operations, and number of emergency operations compared to the same period of the previous year. • In our study, patients whose procedures had to be postponed due to COVID-19 restrictions had mild depression and increased anxiety. • We think that mental health support should be considered as a part of the treatment in this patient group. • In this study we aimed to determine the effect COVID-19 pandemic on the daily urology practice of the level three center located in one of the most affected regions in Turkey. • We also aimed to assess anxiety and depression levels of patients whose procedures and surgeries had to be postponed due to COVID-19-related restrictions. Stepwise approach to cancellations of urological surgeries clinic during this pandemic, quarantine process and social isolation have caused some patients to delay their applications to the clinic or postpone their elective treatments. The extent of the pandemic and its final impact on the health and well-being of the population in the future remain uncertain. During these times, uncertainty brings out fear, anxiety, terror and despair. 4 Previous studies have explored the psychological consequences, its prevalence and related factors of the past outbreaks on healthcare workers. 5 In their study conducted in three hospitals in Toronto, Maunder et al found higher anxiety scores in nurses and healthcare workers who came into contact with patients with severe acute respiratory syndrome. 5 Studies on the COVID-19 outbreak have also reported that both healthcare workers 6 and general population 7 experienced mood and sleep disorders during the pandemic and that their depression and anxiety levels increased. 6, 7 According to the data from Turkish Ministry of Health, the first COVID-19 case was seen on March 10, 2020 and since then until June 15, 2020 a total of 199 906 cases and 5131 death were observed in Turkey. 8 During the pandemic, our hospital, which provides level 3 services, has been declared a pandemic hospital. This has caused the patients' admission to be delayed, their treatment being interrupted or their elective treatments to be postponed. To the best of our knowledge, there is no study evaluating the anxiety levels of patients whose clinic applications or elective surgeries were delayed during the COVID-19 period. In this study, we compared the number of urology outpatient admissions, emergency consultations, total number of surgeries and outpatient procedures during the COVID-19 pandemic with the same period of 2019. At the same time, we aimed to evaluate the change in anxiety scores of patients whose procedures and operations were delayed due to pandemicrelated restrictions. State-Trait Anxiety Inventory (STAI), which assesses baseline (trait) and situational (state) anxiety via self-reported questionnaire was used to evaluate patients' anxiety levels. 9 Each part of this questionnaire consists of 20 multiple choice questions and the overall score ranges from 20 to 80, with higher scores indicating higher level of anxiety. Patients with the STAI scores of ≤35 were considered as having "no anxiety", patients with scores between 35 and 42 were considered as having "moderate anxiety", while patients with scores of ≥42 were considered as "severely anxious" as recommended by the guidelines. 10 The validation of this inventory in Turkish population was conducted by Le-Compte and Oner. 11 Depression scores of the patients were evaluated with Beck Depression Inventory (BDI)-II. 12 Turkish validation was done by Akturk et al 13 Patients who were thought to be incapable of filling these forms were excluded from the study. The mean age of all our patients (34 females, 62 males) was (Figures 1 and 2) . The least amount of change was seen in the number of emergency consultations. The evaluation of anxiety and depression scores of the patients showed a significant difference between their STAI-S and STAI-T scores (51.8 ± 9.3, 38.2 ± 7.5, respectively) (P < .001). STAI-S scores of the patients were found to be compatible with severe anxiety. The patients' mean BDI score was found to be 15 ± 8.9, which indicated mild depression. The evaluation between group 1 (n: 40) and group 2 (n: 56) showed no significant difference in the gender, STAI-T and BDI scores, while the age and STAI-S values were significantly higher in group 1 ( Table 2) . Baseline anxiety scores (STAI-T) were similar in both groups, but there was an increase in STAI-S scores in both groups during COVID 19 period. This increase was significant in the oncological patient group ( Table 2 ). The COVID-19 pandemic has brought unprecedented medical and economic challenges. 1 It is known that any COVID-19 carrier who is in the incubation period or asymptomatic can transmit the disease. 2 Therefore, any patient who applies to the urology outpatient clinic for examination is likely to be a COVID-19 carrier. Since patients with urological problems have a higher average age and higher morbidity rates, it is essential to take precautionary measures against COVID-19 in the urology department. 14 pandemic. 3, 15 According to most studies, COVID-19-related decrease in outpatient services ranged from 40% to 80%. 16, 17 Since in-person visits were restricted, some healthcare professionals provided services via telemedicine. 16 services. [20] [21] [22] In their meta-analysis, S. Pappa et al noted that a significant proportion of healthcare workers experienced mood and sleep disturbances during the COVID-19 outbreak. They also stated that female healthcare professionals and nurses showed higher rates of affective symptoms compared with male medical staff, revealing gender and occupational differences. 6 In another population-based study aimed to evaluate the depression and anxiety of people in Hong Kong during the COVID-19 pandemic, 19% of the 500 participants had depression and 14% had anxiety. In addition, 25.4% of participants reported that their mental health has deteriorated since the pandemic. 7 Bohlken et al reported that during the COVID-19 pandemic, doctors in Germany were more anxious and showed depressive symptoms. 23 Another study that compared healthcare workers and members of the society during the COVID-19 pandemic reported that the levels of hopelessness and anxiety in healthcare workers were higher than non-healthcare workers. They also noted that among healthcare professionals those levels were higher among nurses compared with physicians and other healthcare professionals. 24 When the COVID-19 epidemic is evaluated in all these aspects, it is not surprising that it affects the society as a whole for similar reasons and manifests itself with symptoms of anxiety and depression. As mentioned above, there are many studies reporting the symptoms of anxiety and depression in healthcare professionals and the general public. 7, 23, 24 In this study, where we evaluated the anxiety and depression scores of patients whose procedures or elective surgeries were postponed due to COVID-19 restrictions, we found that the anxiety levels of the patients increased and were higher than their baseline anxiety scores. Anxiety scores of oncological patients in group 1 were found to be higher. Fear of cancer progression in these patients is thought to be the main source of this concern. On the other hand, when the BDI of all patients were evaluated, the depression scores were compatible with mild depression, which might be because of the prolonged waiting times that may have deepened anxiety and depression. Our study covers a specific group of patients whose procedures or operations were postponed due to COVID-19 restrictions. This is the first study in the literature that examines the change in anxiety The COVID-19 pandemic has caused serious changes in healthcare systems around the world. We detected a dramatic decrease in the number of patients applying and being admitted to the outpatient clinic, number of emergency consultations, number of hospitalised patients, total number of operations and number of emergency operations compared with the same period of the previous year. In addition, elective surgeries were postponed and priority was given to emergency urological situations and high-grade malignancies. In our study, patients whose procedures had to be postponed due to COVID-19 restrictions had mild depression and increased anxiety. We hope that our findings will provide data to support targeted interventions in mental health for Turkish and worldwide population during such pandemics. We think that mental health support should be considered as a part of the treatment in this patient group. None. All authors declared that there is no conflict of interest. UM and EK: study design, data analysis, manuscript writing. UM, EK, BO and CY: manuscript editing. UM, MHÖ and EK: data collection. UM, EK, MCC and YOI: participated in designing the study, study coordination, data collection and supervision. All authors have critically reviewed the manuscript and have approved the final version submitted for publication. This study was conducted in accordance with the declaration of 1964 Helsinki and also with approval from the institutional ethics committee. Informed consent was obtained from all individual participants included in the study. The authors declare that they have followed the protocols of their work centre on the publication of patient data. World Health Organization. Coronavirus disease (COVID-19) pandemic Familial cluster of infection associated with the 2019 novel coronavirus indicating possible personto-person transmission during the incubation period Considerations in the triage of urologic surgeries during the COVID-19 pandemic EDITORIAL: COVID-19 and anxiety and depression in 2020 Factors associated with the psychological impact of severe acute respiratory syndrome on nurses and other hospital workers in Toronto Prevalence of depression, anxiety, and insomnia among health care workers during the COVID-19 pandemic: a systematic review and meta-analysis Depression and anxiety in Hong Kong during COVID-19 Republic of Turkey Ministry of Health State-Trait Anxiety Inventory For Adults, Self Evaluation Questionnaire STAI formY-1 and Y-2 The development of a six-item short-form of the state scale of the Spielberg State-TraitAnxiety Inventory (STAI) A study related to adaptation and standardization of state-trait anxiety inventory into Turkish Beck Depression Inventory Manual The reliability and validity analysis of the Turkish version of beck depression inventory for primary care Clinical features of COVID-19 in elderly patients: a comparison with young and middle-aged patients COVID-19: recommendations for management of elective surgical procedures 2020 The impact of COVID-19 on urologic practice, medical education, and training Impact of COVID-19 on urology practice: a global perspective and snapshot analysis Impact de la pandemie de COVID-19 sur l'activite chirurgicale au sein des services d'urologie de l'Assistance Publique -Hopitaux de Paris The early impact of COVID-19 pandemic on surgical urologic oncology practice in Turkey: multiinstitutional experience from different geographic areas The Psychology of Pandemics: Preparing for the Next Global Outbreak of Infectious Disease Risk perception and impact of severe acute respiratory syndrome (SARS) on work and personal lives of healthcare workers in Singapore: what can we learn? Pneumonia causes panic in Guangdong province COVID-19 pandemic: stress experience of healthcare workers -a short current review Anxiety and hopelessness levels in COVID-19 pandemic: a comparative study of healthcare professionals and other community sample in Turkey